骨骼未成熟患者内侧髌股韧带重建：股骨远端骨骺固定与近端固定的比较
简介
该回顾性研究纳入23例骨骺未闭的髌骨不稳患者（24膝），比较MPFL重建中股骨固定点位于骨骺近端与远端的临床结果。两组在Tegner、Kujala、Lysholm及IKDC评分、重返运动率（均为91.7%）方面无显著差异，且均无再脱位或生长干扰。虽近端固定组并发症（41.7% vs. 24.9%）略高，但差异无统计学意义，提示两种固定方式效果相当，但样本量小…
英文摘要
PURPOSE: To compare clinical outcomes and complications of medial patellofemoral ligament (MPFL) reconstruction using femoral fixation proximal versus distal to the physis in skeletally immature patients with patellar instability. METHODS: This retrospective study included 23 skeletally immature patients (24 knees) undergoing isolated MPFL reconstruction from January 2021 to August 2024. Patients were divided into proximal (n = 12 knees, mean age 14.1 ± 0.9 years ) and distal (n = 12 knees, mean age 13.8 ± 1.6 years ) physis fixation groups. Preoperative imaging assessed patellar height, trochlear dysplasia, and the tibial tuberosity-trochlear groove (TT-TG) distance. Clinical outcomes (Tegner, Kujala, Lysholm and International Knee Documentation Committee [IKDC]) and complications (re-dislocation, patellar fracture, infection, stiffness, quadriceps weakness and growth disturbance) were compared. RESULTS: The mean follow-up durations were 24.4 ± 4.3 months (range, 17-33) in the proximal group and 22.8 ± 4.7 months (range, 17-30) in the distal group (P = 0.374). Both groups showed significant improvements in all functional outcomes (P < 0.001) with no intergroup differences (P > 0.05). Subjective satisfaction was similar (8.5 vs. 8.3, P = 0.726). Return to sport occurred in 91.7% of both groups. Complication rates were numerically higher in the proximal group (41.7%; mainly knee pain (n = 3, 25%) and quadriceps weakness (n = 2, 16.7%) than in the distal group (24.9%; infection (n = 1, 8.3%), pain (n = 1, 8.3%), weakness (n = 1, 8.3%)(P = 0.667). No redislocations, patellar fractures, stiffness, or growth disturbances occurred. CONCLUSIONS: Both proximal and distal femoral physis fixation for MPFL reconstruction yield similar clinical outcomes and complication rates in skeletally immature patients. However, due to the limited sample size of this study, the current conclusion should be interpreted with caution.